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Comparison of different lymph node staging systems in patients with node-positive cervical squamous cell carcinoma following radical surgery
Objective: We compared the prognostic accuracy of four lymph node (LN) staging systems - the 2018 International Federation of Gynecology and Obstetrics (FIGO) stage, number of positive lymph node (PLN), metastatic lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) systems - in pati...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Ivyspring International Publisher
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646177/ https://www.ncbi.nlm.nih.gov/pubmed/33193898 http://dx.doi.org/10.7150/jca.48085 |
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author | Guo, Qinhao Zhu, Jun Wu, Yong Wen, Hao Xia, Lingfang Yu, Min Wang, Simin Ju, Xingzhu Wu, Xiaohua |
author_facet | Guo, Qinhao Zhu, Jun Wu, Yong Wen, Hao Xia, Lingfang Yu, Min Wang, Simin Ju, Xingzhu Wu, Xiaohua |
author_sort | Guo, Qinhao |
collection | PubMed |
description | Objective: We compared the prognostic accuracy of four lymph node (LN) staging systems - the 2018 International Federation of Gynecology and Obstetrics (FIGO) stage, number of positive lymph node (PLN), metastatic lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) systems - in patients with node-positive cervical squamous cell carcinoma (CSCC) following radical surgery and explored the optimal choice for clinical applications. Materials and methods: Data were retrospectively collected from 928 node-positive CSCC patients who underwent radical surgery between 2006 and 2014 in our center. Tree-based recursive partitioning was applied to split variables (PLN, LNR, and LODDS) into low-risk and high-risk groups. The log-rank test was used to compare survival curves, and Cox regression analysis was performed to identify prognostic factors. The relative discriminative abilities of the different staging systems were assessed using Harrell's concordance index (C index) and the Akaike information criterion (AIC). Results: The mean number of PLNs was 3.8 (range: 1-44 nodes). According to the 2018 FIGO staging system, 831 patients had stage IIIC1, and 97 had stage IIIC2. For the PLN system, 761 patients were included in the low-risk group, and 167 were included in the high-risk group. For the LNR system, 658 patients were included in the low-risk group, and 270 were included in the high-risk group. The low-risk LODDS group included 694 patients, while the high-risk LODDS group included 234 patients. All four staging systems had a significant influence on patients' progression-free survival (PFS, P < 0.001) and overall survival (OS, P < 0.001). Univariate analysis and multivariate Cox analysis adjusted for significant factors indicated that the four staging systems were significant prognostic factors for PFS and OS. Among them, the PLN system was noted to have the best prognostic performance for both PFS (C index: 0.582; AIC: 8213.33) and OS (C index: 0.624; AIC: 8433.80). Conclusion: The PLN system seemed to be the most accurate LN staging method for predicting node-positive CSCC following radical surgery. |
format | Online Article Text |
id | pubmed-7646177 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Ivyspring International Publisher |
record_format | MEDLINE/PubMed |
spelling | pubmed-76461772020-11-12 Comparison of different lymph node staging systems in patients with node-positive cervical squamous cell carcinoma following radical surgery Guo, Qinhao Zhu, Jun Wu, Yong Wen, Hao Xia, Lingfang Yu, Min Wang, Simin Ju, Xingzhu Wu, Xiaohua J Cancer Research Paper Objective: We compared the prognostic accuracy of four lymph node (LN) staging systems - the 2018 International Federation of Gynecology and Obstetrics (FIGO) stage, number of positive lymph node (PLN), metastatic lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) systems - in patients with node-positive cervical squamous cell carcinoma (CSCC) following radical surgery and explored the optimal choice for clinical applications. Materials and methods: Data were retrospectively collected from 928 node-positive CSCC patients who underwent radical surgery between 2006 and 2014 in our center. Tree-based recursive partitioning was applied to split variables (PLN, LNR, and LODDS) into low-risk and high-risk groups. The log-rank test was used to compare survival curves, and Cox regression analysis was performed to identify prognostic factors. The relative discriminative abilities of the different staging systems were assessed using Harrell's concordance index (C index) and the Akaike information criterion (AIC). Results: The mean number of PLNs was 3.8 (range: 1-44 nodes). According to the 2018 FIGO staging system, 831 patients had stage IIIC1, and 97 had stage IIIC2. For the PLN system, 761 patients were included in the low-risk group, and 167 were included in the high-risk group. For the LNR system, 658 patients were included in the low-risk group, and 270 were included in the high-risk group. The low-risk LODDS group included 694 patients, while the high-risk LODDS group included 234 patients. All four staging systems had a significant influence on patients' progression-free survival (PFS, P < 0.001) and overall survival (OS, P < 0.001). Univariate analysis and multivariate Cox analysis adjusted for significant factors indicated that the four staging systems were significant prognostic factors for PFS and OS. Among them, the PLN system was noted to have the best prognostic performance for both PFS (C index: 0.582; AIC: 8213.33) and OS (C index: 0.624; AIC: 8433.80). Conclusion: The PLN system seemed to be the most accurate LN staging method for predicting node-positive CSCC following radical surgery. Ivyspring International Publisher 2020-10-23 /pmc/articles/PMC7646177/ /pubmed/33193898 http://dx.doi.org/10.7150/jca.48085 Text en © The author(s) This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions. |
spellingShingle | Research Paper Guo, Qinhao Zhu, Jun Wu, Yong Wen, Hao Xia, Lingfang Yu, Min Wang, Simin Ju, Xingzhu Wu, Xiaohua Comparison of different lymph node staging systems in patients with node-positive cervical squamous cell carcinoma following radical surgery |
title | Comparison of different lymph node staging systems in patients with node-positive cervical squamous cell carcinoma following radical surgery |
title_full | Comparison of different lymph node staging systems in patients with node-positive cervical squamous cell carcinoma following radical surgery |
title_fullStr | Comparison of different lymph node staging systems in patients with node-positive cervical squamous cell carcinoma following radical surgery |
title_full_unstemmed | Comparison of different lymph node staging systems in patients with node-positive cervical squamous cell carcinoma following radical surgery |
title_short | Comparison of different lymph node staging systems in patients with node-positive cervical squamous cell carcinoma following radical surgery |
title_sort | comparison of different lymph node staging systems in patients with node-positive cervical squamous cell carcinoma following radical surgery |
topic | Research Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646177/ https://www.ncbi.nlm.nih.gov/pubmed/33193898 http://dx.doi.org/10.7150/jca.48085 |
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